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1.
目的 探索精神分裂症患者及其健康同胞是否具有相似的脑白质完整性受损.从而为该异常是否为精神分裂症的易感性生物学特征提供依据.方法 利用基于像素的全脑分析方法比较精神分裂症患者30例及其健康同胞30名和正常对照30名的脑白质密度,将组间有差异的区域作为感兴趣区,利用纤维追踪技术重建穿过这些区域的白质纤维柬,比较三组之间纤维束的各向异性值(FA).结果 精神分裂症患者组及其同胞组左侧前额叶的各向异性低于正常对照组[(0.296±0.030),(0.302±0.030),(0.326±0.026),P<0.05],两组的胼胝体膝部的各向异性也低于正常对照组[(0.560±0.031),(0.568 ±0.025),(0.581 ±0.028),P<0.05],但患者组与同胞组之间的上述差异均无统计学意义(P>0.05).结论 左侧前额叶和胼胝体膝部白质完整性受损可能是精神分裂症的易感性生物学特征.  相似文献   

2.
首发精神分裂症阳性症状为主型患者脑弥散张量成像研究   总被引:2,自引:2,他引:0  
目的 探讨首发精神分裂症阳性症状为主型患者主要脑区白质纤维束有无异常.方法 对未系统使用过精神药物治疗的20例首发精神分裂症阳性症状为主型患者和20名正常对照进行磁共振弥散张量成像(DTI)扫描,测量胼胝体膝部、压部、双侧额叶白质、双侧扣带束前部和双侧海马头部分各向异性(FA)值.结果 ①患者组及对照组组内比较,左右侧FA值差异均无统计学意义(P>0.05).②患者组左侧海马头和胼胝体压部FA值[(0.17±0.03),(0.73±0.09)]显著低于对照组[(0.20±0.02),(0.79±0.05)],差异均有统计学意义(P<0.05);③患者组左右侧扣带束前部FA值[(0.28±0.06),(0.29±0.05)]低于对照组[(0.43±0.07),(0.38±0.08)],差异均有统计学意义(P<0.01).结论 首发精神分裂症阳性症状为主型患者双侧扣带束前部、胼胝体压部及左侧海马头的白质纤维束完整性受损,提示其可能存在脑神经发育连接异常.  相似文献   

3.
目的探讨首发未用药的偏执型精神分裂症患者的多个脑区白质磁共振弥散张量成像(diffusion tensor imaging,DTI)的特点,以期为精神分裂症"脑内连接异常的假说"提供依据。方法选取20例首发偏执型精神分裂症患者,应用DTI扫描,检测脑内21个感兴趣区(regions of interest,ROI)白质纤维的微细结构,并与20名年龄、性别和文化程度相匹配的正常对照比较。结果患者组额叶、内囊前肢、外囊的左右两侧FA值和左侧颞叶、左侧内囊膝部、胼胝体膝部FA值小于对照组(P0.05)。患者组额叶左右侧FA值差异无统计学意义(P0.05),而对照组左侧大于右侧(P0.05);患者组内囊膝部和后肢FA值右侧大于左侧(P0.05),而对照组左侧大于右侧(P0.05)。患者组双侧外囊FA值均小于对照组(P0.05)。结论未用药首发偏执型精神分裂症患者脑内多个白质区部分各向异性降低,尤其是额叶皮层下环路更加显著,数个白质区部分各向异性的正常"左右"的偏侧性缺失或倒置,支持精神分裂症脑内连接异常的神经病理假说。  相似文献   

4.
精神分裂症首次发病患者的脑扩散张量成像研究   总被引:2,自引:0,他引:2  
目的 利用磁共振扩散张量成像(DTI)技术研究未经药物治疗的精神分裂症首次发病(以下简称首发)患者主要脑区白质纤维束的异常.方法 选取26例首发精神分裂症患者(患者组)和20名健康志愿者(对照组)行脑DTI扫描(两组均为右利手),测量胼胝体膝部、压部、双侧额叶白质、扣带束前部及海马头的部分各向异性(FA)值.结果 (1)对照组左侧扣带束FA值(0.428±0.067)大于右侧(0.375±0.079;P<0.05).(2)患者组两侧相对应感兴趣区FA值差异均无统计学意义(P>0.05).(3)患者组左右侧胼胝体压部FA值(均为0.734±0.085)、左右侧扣带束前部FA值(0.300±0.068和0.306 4±0.062)均低于对照组(0.785±0.045,0.428±0.067,0.375±0.079;均P<0.05).结论 首发精神分裂症患者存在双侧扣带束、胼胝体压部白质纤维束的受损,支持脑内连接异常假说.  相似文献   

5.
目的探讨双相抑郁患者前额叶及海马磁共振质子波谱(proton magnetic resonance spectroscopy,1H-MRS)的代谢物变化特点,为其神经生物学研究提供线索。方法应用磁共振质子波谱成像技术检测26例双相抑郁患者(患者组)和26例单相抑郁患者及13例健康志愿者(对照组)双侧前额叶白质、前扣带回皮质、海马N-乙酰天门冬氨酸(N-Acetylaspartate,NAA)、胆碱(choline,Cho)、肌酸(creatine,Cr)3种代谢物,以Cr为参照物,分别计算双侧NAA/Cr和Cho/Cr比值。采用SPSS 13.0进行统计处理。结果患者组左侧前额叶白质NAA/Cr(1.65±0.31)低于对照组(2.37±0.36),左侧前额叶白质Cho/Cr(1.35±0.27)低于对照组(1.65±0.21),差异有统计学意义(P<0.05);右侧前额叶白质NAA/Cr、Cho/Cr值与正常对照组差异无统计学意义;患者组双侧前扣带回NAA/Cr、Cho/Cr值与正常对照组差异无统计学意义;患者组双侧海马NAA/Cr、Cho/Cr值与正常对照组差异无统计学意义;患者组与单相抑郁组的双侧额叶白质、双侧前扣带回皮质、双侧海马NAA/Cr、Cho/Cr值差异均无统计学意义。结论双相抑郁患者可能存在左侧前额叶神经元功能下降和膜磷脂代谢异常,其代谢物特点存在偏侧化。  相似文献   

6.
目的分析阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者认知功能与磁共振弥散张量成像(diffusion tensor imaging,DTI)相关性。方法选取2016年08月至2019年07月在海南医学院第二附属医院诊治的40例OSAHS患者(中度组20例,重度组20例)及同期健康志愿者20例(对照组),行常规MRI及DTI检查,并填写中文版简易智能精神状态检查量表(minimentalstateexamination,MMSE),对三组入选者资料进行相关性分析。结果(1)三组入选者在记忆力、注意力和计算力、回忆能力及MMSE总分见比较差异有统计学意义(P0.05);(2)OSAHS中度组与重度组患者双侧额叶白质、前扣带回、后角周围白质及海马旁回等解剖结构的FA值分别与对照组比较明显降低(P0.0167);OSAHS中度组与重度组患者双侧额叶白质、前扣带回及后角周围白质等解剖结构的ADC值分别与对照组比较明显升高(P0.0167);(3)控制年龄、文化程度后选取右侧半球额叶白质、前扣带回、后角周围白质及海马旁回进行分析。记忆力与右侧额叶白质、前扣带回及海马旁回FA值呈正相关(r=0.526、0.467及0.573,P均0.05);注意力和计算力与右侧额叶白质及前扣带回FA值呈正相关(r=0.354、0.387,均P0.05);回忆能力与右侧额叶白质、前扣带回及海马旁回FA值呈正相关(r=0.475、0.375及0.377,均P0.05)。结论DTI是一种非侵入性评价现脑白质完整性、致密性及平行性的影像学检查方法,与MMSE量表结合可反映OSAHS患者认知功能损害程度。OSAHS患者存在多种不同走向的白质纤维受损,记忆力、注意力和计算力、回忆能力受损程度与右侧额叶白质、前扣带回及海马旁回受损程度呈正相关。  相似文献   

7.
目的通过磁共振弥散张量成像研究不同区域脑白质损害与轻度认知功能(MCI)的关系。方法纳入2015年7月至2016年2月我院的住院患者56例为研究对象,其中MCI组34例,认知功能正常组22例。所有研究对象进行一般情况检查,完成神经心理学量表检测。通过头颅磁共振弥散张量成像(DTI)检查对不同脑区白质纤维进行部分各向异性(FA)值测量。结果 MCI组患者与认知功能正常组相比,右侧额叶FA值(0.335±0.068)、左侧颞叶白质FA值(0.391±0.032)及胼胝体膝部FA值(0.658±0.053)降低,差异具有统计学意义(P0.05)。将上述FA值和MMSE、Mo CA量表中各认知域进行典型相关分析,结果显示右侧额叶白质FA值与注意与计算力呈正相关,左侧颞叶白质和胼胝体膝部FA值与记忆力呈正相关(P0.05)。结论 MCI患者注意与计算力的障碍可能与右侧额叶白质损害有关,而左侧颞叶白质及胼胝体膝部白质的损害可能导致早期的记忆障碍。DTI可能成为超早期识别与诊断MCI的新方法。  相似文献   

8.
目的利用磁共振弥散张量成像(DTI)技术,观察养血清脑颗粒治疗卒中后抑郁(PSD)的疗效差异,以及其对脑白质结构改变的影响。方法给予卒中后抑郁患者养血清脑颗粒4 g,口服,3次/d;疗程12 w,治疗前、后均收集汉密尔顿抑郁量表评分(HAMD-24)、DTI扫描数据。治疗后HAMD-24≤8分纳入治愈组,反之纳入难治组。比较两组治疗前、后FA值变化情况。结果养血清脑颗粒治愈率约44.6%。与治疗前相比,治愈组的左侧额叶FA值治疗后明显升高(P0.05);比较两组治疗前的FA值,发现难治组左侧额叶、右侧海马的基线FA值低下(P0.05)。结论养血清脑颗粒治疗PSD有效。PSD患者存在可逆性前额叶深部白质损伤;且难治性PSD患者左侧额叶、右侧海马的基线FA值低下,提示DTI可作为抗抑郁疗效评估的预测指标。  相似文献   

9.
目的探讨PD伴抑郁与脑组织感兴趣区微观结构变化的相关性。方法根据DSM-IV将40例PD患者分成PD伴抑郁组和PD非抑郁组;对2组进行DTI检查,测定感兴趣区的FA值,对PD伴抑郁组患者行汉密尔顿抑郁量表评估。结果 PD伴抑郁组额叶白质FA值(0.307±0.044)、扣带回前部白质FA值(0.297±0.02)较PD非抑郁组额叶白质FA值(0.370±0.31)、扣带回前部白质FA值(0.324±0.02)明显下降,(P0.05),其余各ROI的FA值无明显差异(P0.05)。PD伴抑郁与额叶白质及扣带回前部白质FA值有关(OR=0.00,OR=0.00,P0.05)。PD伴抑郁组患者额叶白质、扣带回前部白质FA值与HAMD量表得分呈负相关(r=-0.615,r=-0.515,P0.05)结论 PD伴抑郁患者额叶及扣带回前部白质微观结构存在变化,且此种变化的严重程度与抑郁程度有关。  相似文献   

10.
目的通过磁共振弥散张量成像技术(diffusion tensor imaging,DTI)研究动态血压对高血压患者脑白质的影响,明确脑白质早期损害特点并探讨相关的危险因素。方法选取原发性高血压患者26例为高血压组,选择同期健康体检者19例为对照组,将脑白质部位的各向异性分数(fractional anisotropy,FA)、平均弥散系数(mean diffusion coefficient,MD)与动态血压参数的相关性进行分析。结果与对照组比较,高血压组24hSBP、dSBP、nSBP水平明显升高,差异均有统计学意义(P0.05);2组24hSBP-CV、dSBP-CV、24hSBP-谷峰值差异有统计学意义(P0.05)。高血压组非杓型血压节律明显高于对照组,可达38.45%。2组侧脑室前脚、后脚、半卵圆中心FA、MD值差异均有统计学意义(P0.05),2组侧脑室体部、额叶皮层下白质区域ROI区的DTI参数比较,FA值差异有统计学意义(P0.05),而颞叶、顶叶、枕叶皮层下白质的FA值、MD值差异均无统计学意义(P0.05)。结论高血压对脑白质早期损害的部位主要在侧脑室前脚、后脚及半卵圆中心,侧脑室体部及额叶皮层下白质区也存在一定程度的损害。血压水平的升高及血压变异均是导致脑白质早期损伤的因素。  相似文献   

11.
Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.  相似文献   

12.
Diagnostic Difficulties and Treatment Implications   总被引:1,自引:0,他引:1  
Robert J. Gumnit 《Epilepsia》1987,28(S3):S9-S13
Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.  相似文献   

13.
Cognitive Dysfunction Associated with Antiepileptic Drug Therapy   总被引:7,自引:5,他引:2  
Eileen P.G. Vining 《Epilepsia》1987,28(S2):S18-S22
Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.  相似文献   

14.
B. J. Wilder 《Epilepsia》1987,28(S2):S1-S7
Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.  相似文献   

15.
Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.  相似文献   

16.
Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.  相似文献   

17.
Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity   总被引:5,自引:1,他引:4  
G. Trube  R. Netzer 《Epilepsia》1994,35(S5):S62-S67
Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.  相似文献   

18.
Hepatic Considerations in the Use of Antiepileptic Drugs   总被引:5,自引:4,他引:1  
Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.  相似文献   

19.
Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.  相似文献   

20.
Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.  相似文献   

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